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DOCTOR OF BUSINESS ADMINISTRATION (DBA) CONFIDENTIAL REFERENCE FORM


The person named below has applied for admission to a Doctor of Business Administration degree
offered through the Gordon Institute of Business Science. The information which you provide will
assist us in evaluating his/her application.

ALL INFORMATION SUPPLIED WILL BE TREATED IN THE STRICTEST CONFIDENCE.

1. APPLICANT DETAILS:

PLEASE ENTER YOUR NAME AND DATE OF BIRTH ON THE FORM, AND SEND IT TO 2
PEOPLE YOU WISH TO WRITE THIS RECOMMENDATION. ASK YOUR REFEREE TO FAX THE
COMPLETED FORM DIRECTLY TO THE DBA PROGRAMME DIRECTOR AT 086 638 0519.

1.1 SURNAME: _____________________________________________________________

1.2 FIRST NAME(S):_________________________________________________________

1.3 DATE OF BIRTH: _________________________________________________________


TO THE REFEREE:

Thank you for taking the time to write on behalf of this applicant. We value your direct contact with
the applicant, which contributes to distinguishing the most suitable candidates from among a pool of
well-qualified young professionals. We ask for your personal and candid opinion on the applicant's
personal qualities and his or her potential for a senior position in management or knowledge
leadership.

Please answer the questions listed. We will acknowledge the Reference Form in writing. The
contents of your recommendation will not be communicated to any person who is not directly involved
in the admission process, nor to the applicant. We appreciate your efforts on behalf of this applicant,
and look forward to hearing from you.


2. DETAILS OF REFEREE COMPLETING THIS FORM:

2.1 SURNAME: ___________________________________________________________________

2.2 FIRST NAME: _________________________________________________________________

2.3 ORGANISATION: ______________________________________________________________

2.4 POSITION: ___________________________________________________________________

2.5 POSTAL ADDRESS: ____________________________________________________________

2.6 COUNTRY: _______________________________________POSTAL CODE: __________________

2.7 E-MAIL:_______________________________________________________________________

2.8 TELEPHONE: ________________________________FAX______________________________
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3. HOW LONG HAVE YOU KNOWN THE APPLICANT? DEFINE YOUR RELATIONSHIP WITH
THE APPLICANT AND THE CIRCUMSTANCES IN WHICH YOU MET.

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NB Since GIBS reserves the right to verify all credentials and information on an applicant's
file, please ensure you have indicated where you can be reached.


4. PLEASE RATE THE APPLICANT ON THE FOLLOWING CRITERIA. CHOOSE ONE OF THE
RATINGS BELOW (1 – 6) AND ENTER THE CORRESPONDING NUMBER TO THE RIGHT OF
EACH CHARACTERISTIC.

   1   Outstanding - Top 2%
   2   Very good - Top 10%
   3   Above average - Top 25%
   4   Average - Top 50%
   5   Below average - Bottom 50%
   6   Unobserved

4.1 COMPETENCE IN HIS/HER FIELD_________________________________________________

4.2 PROFESSIONALISM ___________________________________________________________

4.3 FOCUS ON THE TASK AT HAND__________________________________________________

4.4 READINESS TO USE OPPORTUNITIES FOR ACHIEVEMENT___________________________

4.5 CREATIVITY AND RESOURCEFULNESS___________________________________________

4.6 INTELLECTUAL CURIOSITY_____________________________________________________

4.7 ENERGY AND DRIVE __________________________________________________________

4.8 PERSONAL INTEGRITY_________________________________________________________

4.9 ABILITY TO WORK IN A TEAM____________________________________________________

4.10 ORGANISATIONAL ABILITY_____________________________________________________

4.11 ORAL COMMUNICATION SKILLS________________________________________________

4.12 WRITTEN COMMUNICATION SKILLS_____________________________________________
                                       -3-

5. HOW DO YOU RATE THE APPLICANT'S POTENTIAL FOR BECOMING A RESPONSIBLE AND
SUCCESSFUL KNOWLEDGE LEADER COMPARED WITH OTHER STUDENTS OR EMPLOYEES
WHOM YOU HAVE KNOWN IN A SIMILAR CAPACITY?

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6. PLEASE GIVE YOUR ANSWERS TO THE FOLLOWING QUESTIONS AND WE ENCOURAGE
YOU TO BE AS CANDID AS POSSIBLE (Max 10 lines)

6.1 COMMENT ON THE APPLICANT'S CAREER PROGRESS TO DATE AND HIS/HER CAREER
FOCUS.

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6.2 WHAT DO YOU CONSIDER TO BE THE APPLICANT'S MAJOR STRENGTHS? COMMENT
ON THE FACTORS THAT DISTINGUISHED THE APPLICANT FROM OTHER INDIVIDUALS AT
HIS/HER LEVEL.

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6.3 WHAT DO YOU CONSIDER TO BE THE APPLICANT'S MAJOR WEAKNESSES? COMMENT
ON HIS/HER EFFORTS TO IMPROVE THEM.

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6.4 DESCRIBE ANY SITUATION(S) OR INCIDENT(S) BASED ON FIRST HAND EXPERIENCE
WHICH ILLUSTRATE(S) THE APPLICANT'S SENSE OF PURPOSE AND MATURITY.

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6.5 COMMENT ON THE APPLICANT'S POTENTIAL FOR A SENIOR POSITION IN
MANAGEMENT OR KNOWLEDGE LEADERSHIP. DESCRIBE AN OCCASION YOU MAY HAVE
HAD TO OBSERVE THE APPLICANT IN A LEADERSHIP ROLE.

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6.6 DESCRIBE THE APPLICANT'S INTERPERSONAL SKILLS. COMMENT ON HIS/HER ABILITY
TO ESTABLISH AND MAINTAIN RELATIONSHIPS, SENSITIVITY TO OTHERS, SELF-
CONFIDENCE, ATTITUDE, ETC. SPECIFICALLY COMMENT ON THE APPLICANT'S
BEHAVIOUR OR SKILLS IN A GROUP SETTING/TEAM ENVIRONMENT.

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6.7 ANY ADDITIONAL COMMENTS THAT WOULD BE OF ASSISTANCE TO THE SELECTION
COMMITTEE.

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